The rationale and toxicity of combined cranial radiotherapy and immune checkpoint inhibitors in non-small cell lung cancer.

The rationale and toxicity of combined cranial radiotherapy and immune checkpoint inhibitors in non-small cell lung cancer. Asia Pac J Clin Oncol. 2020 Mar 04;: Authors: Chen Y, Zhuang H, Wang J Abstract Cranial radiation therapy (CRT) remains to be the foundation stone of the management of brain metastases in non-small cell lung cancer (NSCLC). Nevertheless, the care of NSCLC, recently, has been remarkably reshaped by the immune checkpoint inhibitors (ICIs), such as programmed death protein-1 and programmed death ligand-1 inhibitors, which even showed some efficacy in brain metastases. Furthermore, radiotherapy, traditionally regarded as a therapy via localized cytotoxicity, recently was reported to trigger a systemic immune response, thus probably enhancing the antitumor effect of ICIs. Preliminary datasets confirmed that the combination of these two therapies seemed superior to either monotherapy in NSCLC patients with brain metastases with improved efficacy and comparable toxicity. In this review, we started with discussing the rationale for the combination of CRT and ICIs, then outlined the clinical evidence supporting the high safety of this combined therapy, and finally made a preliminary conclusion on the safety of the combination of CRT and ICIs. PMID: 32129944 [PubMed - as supplied by publisher]
Source: Clinical Lung Cancer - Category: Cancer & Oncology Authors: Tags: Asia Pac J Clin Oncol Source Type: research

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SUMMARY: Treatment options for patients who develop brain metastases secondary to non-small-cell lung cancer have rapidly expanded in recent years. As a key adjunct to surgical and radiation therapy options, systemic therapies are now a critical component of the oncologic management of metastatic CNS disease in many patients with non-small-cell lung cancer. The aim of this review article was to provide a guide for radiologists, outlining the role of systemic therapies in metastatic non-small-cell lung cancer, with a focus on tyrosine kinase inhibitors. The critical role of the blood-brain barrier in the development of syst...
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: ADULT BRAIN Source Type: research
Conclusions: Treatment of patients with ALK + NSCLC with ceritinib or alectinib as post-crizotinib, second-line ALK inhibitor therapy represents a high economic burden. Healthcare costs and resource utilization were significantly higher for patients with ALK + NSCLC with BM versus no BM. PMID: 32347754 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
AbstractPurposeCranial irradiation results in cognitive decline, which is hypothesized to be partially attributable to hippocampal injury and stem cell loss. Recent advances allow for targeted reduction of radiation dose to the hippocampi while maintaining adequate dose coverage to the brain parenchyma and additional increasing dose to brain metastases, a approach called hippocampal avoidance whole brain radiation therapy with a simultaneous integrated boost (HA-WBRT  + SIB.) We review our early clinical experience with HA-WBRT + SIB.Materials and methodsWe evaluated treatments and clinical outc...
Source: Journal of Neuro-Oncology - Category: Cancer & Oncology Source Type: research
This study is a multicenter, prospective, single ‐arm, phase II clinical study, and explores the efficacy and tolerability of SRS with anlotinib in NSCLC patients with limited brain metastases. The aim of the study is to provide new treatment options for NSCLC patients with brain metastases.
Source: Thoracic Cancer - Category: Cancer & Oncology Authors: Tags: STUDY PROTOCOL Source Type: research
Authors: Nakashima K, Demura Y, Oi M, Tabata M, Tada T, Shiozaki K, Akai M, Ishizuka T Abstract We herein report a 66-year-old woman with advanced lung adenocarcinoma (PD-L1 tumor proportion score 60%) lacking driver oncogenes in whom meningeal carcinomatosis, along with sudden onset dizziness, deafness, and consciousness disturbance, appeared after second-line chemotherapy. Whole-brain radiation therapy (WBRT) and Pembrolizumab were subsequently administered, and third-line chemotherapy with Pembrolizumab is now ongoing. At the time of writing, the patient has achieved a 23-month survival without disease progressi...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
The prognosis of non-small-cell lung cancer (NSCLC) with brain metastases is very poor. Currently, therapeutic methods for this patient population include whole-brain radiation therapy (WBRT), surgery, radiosu...
Source: BMC Cancer - Category: Cancer & Oncology Authors: Tags: Research article Source Type: research
Conclusion: In patients presenting with oligometastatic lung cancer limited to the brain, treatment with both lung SBRT and brain SRS achieves good LC of all sites with encouraging OS. PMID: 31956701 [PubMed]
Source: Clinical Lung Cancer - Category: Cancer & Oncology Authors: Tags: Clin Transl Radiat Oncol Source Type: research
Brain metastases often occur at initial diagnosis and/or throughout the disease course of non-small cell lung cancer (NSCLC). Roughly 10% of patients with newly diagnosed NSCLC initially present with brain metastases with the proportion being higher (approximately 30%) in patients with advanced stage NSCLC-adenocarcinomas [1 –3]. Generally, in the management of patients with NSCLC and brain metastases, therapies are often used to achieve local control of brain metastases, including whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), or surgical resection followed by SRS with median overall survival...
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Systematic Review Source Type: research
Abstract BACKGROUND AND PURPOSE: To analyze outcomes of non-small cell lung cancer (NSCLC) patients with brain metastases harboring EGFR or ALK mutations and examine for differences between tyrosine kinase inhibitors (TKIs) alone, radiotherapy (RT) alone (either whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS)), or combined TKIs and RT. MATERIALS AND METHODS: Thirty studies were identified. PATIENTS: with brain metastases from NSCLC. INTERVENTION: initial TKIs alone with optional salvage RT, RT alone, or TKIs and RT. CONTROL: wild-type NSCLC and TKIs alone for mutational ...
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research
Leptomeningeal metastasis (LM) is a devastating and terminal complication of advanced non-small-cell lung cancer (NSCLC), especially in patients harboring epidermal growth factor receptor (EGFR) mutations. The...
Source: Radiation Oncology - Category: Cancer & Oncology Authors: Tags: Research Source Type: research
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